This application is for a Mentored Clinical Scientist Development Award (K23) for Tara Bishop, an Assistant Professor of Public Health and Medicine at Weill Cornell Medical College. Dr. Bishop's career goal is to become a national expert on how organizational structures, external incentives, and regulatory policies affect the quality and use of ambulatory care by older adults. The K23 award will provide Dr. Bishop with the necessary resources 1) to become an expert on the organization of physician practices as they relate to the care of older patients; 2) to develop the skills to perform high level statisticl and qualitative analyses; and 3) to conduct a mixed-methods study of changes in the organization of physician practices and the effects of these changes on the quality of care for older adults. Dr. Bishop has a mentorship team of established researchers: Dr. Lawrence Casalino (primary mentor) who is an Associate Professor of Public Health at Weill Cornell Medical College and an expert on the organization of physician practices and qualitative methods; Dr. Mark Lachs (co-mentor) who is a Professor of Geriatrics at Weill Cornell Medical College and an expert on the healthcare needs of older adults; Dr. Alvin Mushlin (co-mentor) who is Professor and Chair of Public Health at Weill Cornell Medical College and an expert on methods of comparative effectiveness; Dr. Stephen Shortell (co-mentor) who is Professor and Dean of the School of Public Health at the University of California, Berkeley and an expert on the organization of physician practices; Dr. Robert Strawderman (co-mentor) who is a Professor of Statistics at Cornell University and an expert on statistical methods; and Dr. Christine Cassel (advisor) who is President and Chief Executive Officer of the American Board of Internal Medicine and former Chair of Geriatrics at the Mount Sinai School of Medicine and is an expert on the healthcare needs of older adults. Older adults receive a substantial amount of their care in the ambulatory setting; however many older adults do not receive high quality ambulatory care. Organizational structure has been linked to the use of processes to improve quality and quality outcomes. Dr. Bishop's research will look at changes in the organization of physician practices, specifically a potentially emerging trend for hospitals to own physician practices (Aim 1), differences in the use of processes to improve quality in practices that are owned by hospitals versus those that are owned by physicians (Aim 2), differences in the quality of care delivered to older adults by physicians in hospital-owned practices versus physician-owned practices (Aim 3), and physician perception of the barriers of and facilitators for providing high quality care to older adults when a practice changes ownership (Aim 4). This research will be the foundation for an R01 grant application (at the end of the K award period) that will develop measures of processes to improve care for patients with geriatric syndromes and that will survey physician organizations on the use of these processes.